Partner notification for syphilis in Chile: exploring health care providers’ perspectives to enhance public health service delivery

Abstract

Partner Notification (PN) has long been considered an essential strategy for sexually transmissible infection (STI) control, but both policies and methods of implementation vary between countries. Although the provision of clinical services in sexual health has improved in Chile, syphilis among the general population is one of the most commonly reported STIs. This research explores the role of PN in syphilis control in public health services in Chile.

A qualitative case study was designed, and two regional Health Services, each representing a single case, were recruited. Different data collection methods were used to obtain information from different sources. A qualitative document analysis was carried out using the latest national regulations and technical documents available on the Ministry of Health website at the beginning of the study (2015) and in April 2018 for information related to PN (12 documents were reviewed). Also, a review of the current syphilis management regulations was performed to contextualise the defined local approach at the two regional Health Services, which was explored through a syphilis management clinic review in each of the 14 primary health care centres and 6 sexual health clinics which participated. Semi-structured face-to-face interviews were conducted in participating health services with 48 health care providers (HCPs), mostly midwives with more than 10 years of professional experience, as well as with 10 key informants from different backgrounds between May and September 2016.

The data collected from the clinic reviews were organised using Microsoft Excel, and from the semi-interviews were transcribed verbatim. Data from both sources were managed using QSR International's NVivo 11 PRO Software. Data were thematically analysed using an inductive approach, with both within-case and cross-case thematic analysis of data from the cases. Selected quotes were translated from Spanish to English. Codes and themes were reviewed and discussed with supervisors.

Findings revealed that syphilis management has a well-organised approach in public health services, but little knowledge or understanding of the infection among patients leads to a lack of recognition of the importance of informing sexual partners about their risk of having syphilis. While guidelines and recommendations highlighted syphilis prevention, PN was not suggested as an essential strategy. The management of partner(s) or sexual contact(s) was acknowledged as critical for syphilis control in the guidelines and by participants, but no document provides comprehensive information about how to deliver PN. Patient referral was the most common approach for PN delivery; however, interviewees commented that index cases do not provide information about their partners easily and the delivery of PN is further impacted by gender and the socio-cultural context of Chile. Eventually, the use of electronic communication technologies could be an alternative for enhancing current approaches. PN was perceived by HCPs as an exhausting, difficult and challenging process due to poor public understanding of syphilis, absence of practical recommendations for delivery and health system limitations.

These findings are important for local and national Chilean authorities. They need to understand how PN has been implemented in these services and the experiences of HCPs in their daily routine. By following international recommendations and by including knowledge gained from this research, current practices and guidelines in Chile could be strengthened to ensure that STI control is enhanced at the population level.